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A recent study published in the Journal of American Medical Association showed a projection that long-term finerenone medication can increase event-free survival in heart failure (HF) patients with modestly decreased or maintained ejection fraction by up to 3 years.

When compared to the peers of same age, the individuals with heart failure who have a little reduced or maintained ejection fraction have a significantly shorter life expectancy free from clinical events. Reductions in cardiovascular events have been observed in this population after a median follow-up of 2.6 years with finerenone, a nonsteroidal mineralocorticoid receptor antagonist. Since patients with HF usually continue treatment after this period, estimating the possible long-term benefits of finerenone could help guide shared clinical decision-making. Thus, this study was to calculate the expected long-term therapeutic effects of finerenone in HF patients who have a modestly decreased or maintained ejection fraction provided the patient receives the medication for the duration of their lives.

The FINEARTS-HF experiment spanned over 653 sites in 37 countries and was subjected to predetermined analysis. From September 2020 to January 2023, the adults 40 years of age and older with HF symptoms and a left ventricular ejection fraction of 40% or above were randomly assigned. The median (IQR) of the follow-up was 2.6 (1.9 to 3.0) years. The time to cardiovascular death or worsening heart attack incident was the main composite outcome. Age-based Kaplan-Meier curves were employed to iteratively estimate the long-term increases in survival free from a major end goal with finerenone. Event-free survival benefits were shown by differences in the areas under the survival curves between the finerenone and placebo groups.

Among 6001 individuals, the mean survival free of a 55-year-old participant from the primary end objective was 13.6 years with finerenone and 10.5 years with placebo which signified a 3.1-year increase in event-free survival. Also, a 65-year-old participant’s mean event-free survival was 11.0 years while using finerenone and 8.9 years when taking a placebo, implying a 2.0-year increase. For every beginning age between 50 and 80 years old, the projected mean event-free survival was numerically higher with finerenone than with placebo. Gains in event-free survival over the course of a lifetime were seen in patients who had previously received treatment with a sodium-glucose cotransporter 2 inhibitor. Overall, the outcome of this trial found that long-term finerenone medication was expected to increase event-free survival by up to 3 years in persons with HFmrEF or HFpEF.

Reference:

Vaduganathan, M., Claggett, B. L., Desai, A. S., Jhund, P. S., Lam, C. S. P., Senni, M., Shah, S. J., Voors, A. A., Zannad, F., Pitt, B., Borentian, M., Lay-Flurrie, J., Viswanathan, P., Behmenburg, F. U., McMurray, J. J. V., & Solomon, S. D. (2024). Estimated Long-Term Benefits of Finerenone in Heart Failure. In JAMA Cardiology. American Medical Association (AMA). https://doi.org/10.1001/jamacardio.2024.3782

For people with ischemic stroke, treatment with the clot-busting drug tenecteplase is associated with a slightly higher likelihood of an excellent recovery and reduced disability three months later than the drug alteplase, according to a meta-analysis published in the October 16, 2024, online issue of Neurology®, the medical journal of the American Academy of Neurology. Researchers found that the likelihood of good recovery was similar between the two treatments.

Ischemic stroke is caused by a blockage of blood flow to the brain and is the most common type of stroke.

Alteplase is the only drug approved by the U.S. Food and Drug Administration (FDA) for ischemic stroke. Tenecteplase, a newer clot-busting drug, is approved for treatment of ischemic stroke in Europe but not in the U.S. It is approved in the U.S. for treating clots blocking coronary arteries and is used off-label for ischemic stroke at some stroke centers.

“When a person has an ischemic stroke, they may be treated with either tenecteplase or alteplase,” said study author Georgios Tsivgoulis MD, PhD, MSc, of the National and Kapodistrian University of Athens in Greece and a Fellow of the American Academy of Neurology. “While treatment with either drug increases the chances of a good recovery after stroke, we found people who were given tenecteplase were more likely to have an excellent recovery.”

For the meta-analysis, researchers reviewed 11 studies that compared the safety and efficacy of treatment with tenecteplase or alteplase within four-and-a-half hours after having a stroke. In those studies, 3,788 people were treated with tenecteplase and 3,757 people were treated with alteplase.

Researchers examined participants’ recovery after three months. They used a scale with a score of zero to six where zero represents no symptoms and six represents death. An excellent recovery was defined as a score of zero to one where one represents no significant disability despite some symptoms. A good recovery was defined as a score of zero to two where two represents slight disability when someone is unable to do all previous tasks but can take care of themselves without help. Reduced disability was defined as a drop of one point or more on the scale at three months.

Researchers found people who were given tenecteplase had a 5% higher likelihood of excellent recovery than people who were given alteplase, as well as a 10% higher likelihood of reduced disability three months after stroke. The chances of a good recovery were similar for both groups.

“Our meta-analysis shows that while both drugs have similar safety and increase the chances of good recovery after stroke, tenecteplase is superior to alteplase with a greater chance of excellent recovery and reduced disability,” said Tsivgoulis. “Our findings support using tenecteplase over alteplase when treating people for ischemic stroke.”

A limitation of the meta-analysis was that while it looked at all available randomized-controlled clinical trials on tenecteplase and alteplase, three of the 11 studies were presented at scientific conferences but not yet published in a scientific journal.

Reference:

Lina Palaiodimou,  Aristeidis H. Katsanos, Guillaume Turc, Alexandros-Georgios Asimakopoulos, and Georgios Tsivgoulis,Tenecteplase vs Alteplase in Acute Ischemic Stroke Within 4.5 Hours A Systematic Review and Meta-Analysis of Randomized Trials, Neurology, https://doi.org/10.1212/WNL.0000000000209903.

Smoking is associated with early dental implant failure particularly at the maxillary location, at both implant and individual level suggests a study published in the Journal of Dentistry.

There is uncertainty about the extent to which smoking influences early dental implant failure.

China: A recent study has delved into the postoperative infection factors associated with retrograde intrarenal surgery (RIRS) combined with negative pressure equipment for treating renal stones.

Promising findings by researchers at Baylor College of Medicine and collaborating institutions could lead to the development of a non-invasive stool test and a new therapy for endometriosis, a painful condition that affects nearly 200 million women worldwide. The study appeared in the journal Med.

“Endometriosis develops when lining inside the womb grows outside its normal location, for instance attached to surrounding intestine or the membrane lining the abdominal cavity. This typically causes bleeding, pain, inflammation and infertility,” said corresponding author Dr. Rama Kommagani, associate professor in the Department of Pathology and Immunology at Baylor. “Generally, it takes approximately seven years to detect endometriosis and is often diagnosed incorrectly as a bowel condition. Thus, delayed diagnosis, together with the current use of invasive diagnostic procedures and ineffective treatments underscore the need for improvements in the management of endometriosis.”

“Our previous studies in mice have shown that the microbiome, the communities of bacteria living in the body, or their metabolites, the products they produce, can contribute to endometriosis progression,” Kommagani said. “In the current study, we took a closer look at the role of the microbiome in endometriosis by comparing the bacteria and metabolites present in stools of women with the condition with those of healthy women. We discovered significant differences between them.”

The findings suggested that stool metabolites found in women with endometriosis could be the basis for a non-invasive diagnostic test as well as a potential strategy to reduce disease progression.

The researchers discovered a combination of bacterial metabolites that is unique to endometriosis. Among them is the metabolite called 4-hydroxyindole. “This compound is produced by ‘good bacteria,’ but there is less of it in women with endometriosis than in women without the condition,” said first author Dr. Chandni Talwar, postdoctoral associate in Kommagani’s lab.

“These findings are very exciting,” Talwar said. “There are studies in animal models of the disease that have shown specific bacterial metabolite signatures associated with endometriosis. Our study is the first to discover a unique metabolite profile linked to human endometriosis, which brings us closer to better understanding the human condition and potentially identifying better ways to manage it.”

Furthermore, extensive studies also showed that administering 4-hydroxyindole to animal models of the disease prevented the initiation and progression of endometriosis-associated inflammation and pain.

“Interestingly, our findings also may have implications for another condition. The metabolite profile we identified in endometriosis is similar to that observed in inflammatory bowel disease (IBD), revealing intriguing connections between these two conditions,” Kommagani said. “Our findings support a role for the microbiome in endometriosis and IBD.”

The researchers are continuing their work toward the development of a non-invasive stool test for endometriosis. They are also conducting the necessary studies to evaluate the safety and efficacy of 4-hydroxyindole as a potential treatment for this condition.

Reference:

Talwar, Chandni et al., Identification of distinct stool metabolites in women with endometriosis for non-invasive diagnosis and potential for microbiota-based therapies, Med, DOI:10.1016/j.medj.2024.09.006